US states say they don’t know how to crack down on American women buying abortion pills from foreign online suppliers.

This year, nine US states with Republican-controlled legislatures passed new restrictions on abortions ranging from bans at six weeks to bans unless the mother’s health is at risk.

In 2018, more than 20,000 US women sought the pills online from providers willing to defy US federal rules over sale of the drugs that induce miscarriage.

The Food and Drug Administration (FDA) has imposed strict rules on distribution and use of abortion pills, but state pharmaceutical regulators said they have no effective way of tracking and policing online orders from foreign doctors and pharmacies.

Between March 2018 and March 2019, nearly 21,000 US women bought abortion pills – many of which are not FDA-approved – online from foreign doctors and pharmacies. Pictured: A pharmacist with pills of the drug Misoprostol in his hand at a pharmacy in Provo, Utah

One of the women who bought such pills online is Kayla, a 24-year-old Mississippi mother-of-two who terminated a pregnancy in January.

She and her husband decided they could neither afford to raise another child nor get an abortion at the nearest clinic in Memphis, Tennessee.

‘I wouldn’t know what to do if I didn’t have access to that,’ said Kayla, who asked to be identified only by her first name. ‘I would probably right now be six months pregnant and miserable. It was my lifesaver.’

Abortion is one of the most divisive issues in the US. Opponents cite religious beliefs about the sanctity of life, while abortion-rights activists say bans rob women of control over their bodies and futures.

Despite strict rules on selling abortion pills, pharmacy boards across the country say they have no way or reliably tracking online orders from foreign doctors.

‘We would only know that if someone were to report it to us,’ said Larry Hadley, executive director of the Kentucky Board of Pharmacy.

Pharmacy board officials in Alabama, Georgia, Louisiana, Missouri, North Dakota and Ohio also said they were not aware of shipments of the drugs from unlicensed, foreign providers or how they would take action against them.

ABORTIONS BILLS PASSED IN 2019

BANNED UNLESS A WOMAN’S HEALTH AT RISK

BANNED AFTER SIX TO EIGHT WEEKS (KNOWN AS THE ‘HEARTBEAT’ BILLS):

Georgia

Kentucky (currently blocked)

Louisiana

Mississippi (currently blocked)

Missouri

Ohio (being challenged)

BANNED AFTER 18 TO 22 WEEKS:

Arkansas

Utah (currently blocked)

Source: Guttmacher Institute, NPR

Between March 2018 and March 2019, some 21,000 U.S. women sought the abortion-inducing pills misoprostol and mifepristone from the Austria-based website AidAccess.org, according to a University of Texas at Austin study.

AidAccess founder Dr Rebecca Gomperts received a letter from the FDA in March warning her to stop prescribing abortion pills. She has ignored it.

‘I am responding to an urgent medical need of my patients,’ Dr Gomperts said. ‘I have a medical duty to do so and I do it.’

The abortion pills are typically priced at a fraction of the hundreds of dollars for a clinic abortion. Dr Gomperts occasionally waives the cost entirely for women who cannot afford it.

‘It’s reasonable to expect that as states make it even more difficult for people to access clinic-based abortion care, more people will seek alternatives including self-managed abortion,’ said Jill Adams, executive director of reproductive rights legal group If/When/How.

In another measure of growing interest PlanCPills.org, a website that rates the safety of online pill providers, said the number of visitors has surged to as high as 8,000 people a day, up from a baseline of about 1,000 over the past few months.

The FDA has sent warning letters to foreign online providers, threatening seizure and injunctions unless they stop selling the abortion pills to American women.

‘We remain very concerned…because this bypasses important safeguards designed to protect women’s health,’ an FDA spokesman said in an email.

But some medical experts describe FDA regulations of these drugs as excessive, saying they pose a relatively low health risk and cause far fewer deaths among US women than natural childbirth.

There is currently only one FDA-approved product, which is typically taken in the first trimester of pregnancy.

The drug thins the uterine lining to prevent the embryo from staying implanted and cause the uterus to contract, inducing a miscarriage.

If women want to take the pill, however, the FDA requires it to be dispensed in a medical office, clinic or hospital.